Adult ADHD: Your questions answered
Posted on 24 June 2019
Adult attention deficit/hyperactivity disorder can be a chronic, costly and debilitating disorder with far-reaching effects on your life – and your family’s. Here’s how treatment can transform your life.
Attention deficit/hyperactivity disorder (ADHD) can leave a trail of destruction and failure in its wake, including broken relationships, hobbled careers, recurrent car accidents and drug or gambling addictions – if left untreated. The good news: it can be managed.
Mistakenly seen as a childhood-only condition by many, this under-diagnosed neurodevelopmental disorder sees an estimated 60 to 70% of patients’ symptoms persist into adulthood, says Professor Renata Schoeman, a Bellville-based psychiatrist with special interests in ADHD and eating, mood and anxiety disorders.
“ADHD is a lifespan disorder,” she explains. “Roughly five out of 100 children have ADHD. About two of them appear to ‘outgrow’ it, but often that’s because the symptoms attenuate or because they become better at managing their symptoms. So, three out of five children will still have to deal with the challenges of ADHD in adulthood.”
Although it can’t be cured, ADHD can be treated successfully. “In fact, it’s one of the most rewarding disorders to treat,” says Professor Schoeman. “If you comply with treatment and accept responsibility for your condition in all aspects of your life, your life can be completely transformed for the better.”
What are ADHD’s warning signs?
ADHD is a strongly-inherited illness and parents often recognise the symptoms in themselves if their child is diagnosed, says Dr Rykie Liebenberg, a Mediclinic Sandton psychiatrist with a special interest in ADHD and anxiety disorders. In 2017, Professor Schoeman and Dr Liebenberg published guidelines for adult ADHD in South Africa to standardise diagnosis and treatment, and disseminate knowledge to local healthcare professionals.
ADHD is characterised by a persistent pattern of three core symptoms: inattention, hyperactivity and impulsivity, which are accompanied by behavioural, cognitive, emotional and social problems, says Dr Liebenberg. “There are three types of ADHD: predominantly inattentive (often referred to as ADD); predominantly hyperactive-impulsive; or a combined type where patients present with both inattention and hyperactive-impulsivity.”
“The inattentive type is often more present in women with ADHD,” says Dr Liebenberg. Inattention manifests behaviourally as difficulty sustaining focus, wandering off tasks, lacking persistence, paralysing procrastination, poor time management, inefficiency and being disorganised.
Hyperactivity refers to excessive motor activity when it isn’t appropriate, or excessive fidgeting, tapping or talkativeness. “It may manifest as extreme restlessness or wearing others out with their activity, being a workaholic, being overscheduled and feeling overwhelmed,” explains Dr Liebenberg.
Impulsivity refers to hasty actions that occur in the moment without forethought. Practically, it may translate into:
▶ Poor management of personal finances
▶ A higher chance of divorce
▶ Less likely to be promoted
▶ Difficulty with interpersonal relationships
▶ Unwanted pregnancies and sexually transmitted diseases
▶ Possible substance abuse or other addiction issues such as internet addiction or gambling
▶ Reckless driving
▶ “Associated symptoms include mood swings, temper outbursts, sleep and appetite disturbances,” adds Dr Liebenberg.
How is adult ADHD diagnosed?
Diagnosis is clinical, which means it needs to be made by a specialist psychiatrist or another healthcare professional with expertise in the diagnosis of ADHD, says Dr Liebenberg. “No computer tests, neuroimaging modalities, electroencephalogram tests (recording of brain activity) or psychometric tests will make the diagnosis. Instead you’ll need to undergo a thorough medical evaluation, including a physical and psychiatric history, and a structured interview.”
If possible, family members, partners or close friends will be interviewed about your childhood behaviour, family and developmental history, current behaviour and symptoms.
Are there co-existing conditions?
Unfortunately, co-existing conditions – known as comorbidities – are high in adult ADHD patients and estimated at more than 70%. “Adults are more likely to suffer from comorbid psychiatric disorders, including mood disorders, anxiety disorders, substance abuse disorders and behavioural disorders, while medical disorders such as asthma, diabetes and hypertension are often less well-controlled. Patients are also at higher risk of unplanned pregnancies and sexually transmitted diseases,” says Professor Schoeman. Depression occurs in up to 40% of cases, adds Dr Liebenberg.
What are your treatment options?
Medication is the first line of treatment for adults and needs to be individualised, says Professor Schoeman. “You can’t apply a standard recipe to every single patient, because there are different predictors of how they will respond. For example, some do better on immediate-release medication, or some may need long-acting medication due to convenience and sustained control. Their circumstances could also change, so you could have a businessman who needs medication while working, but not when he retires, when there’s no routine that he needs to adhere to,” she explains.
Not all medication prescribed overseas is available in South Africa. “We use the stimulant methylphenidate (brands such as Ritalin, Concerta or Contramyl), and non-stimulants such as atomoxetine (Strattera or Inir) or bupropion (Wellbutrin or Inir),” says Professor Schoeman.
However, medication shouldn’t be used in isolation: individual therapy, family therapy and life and social skills therapy are all crucial. “Cognitive behavourial therapy (CBT) for ADHD teaches patients coping skills, including life skills like time management and how to manage their emotions. Family therapy helps heal the damage between family members and helps with parenting skills. Mindfulness awareness therapy to help regulate moods is also recommended,” advises Professor Schoeman.
The duration of therapy isn’t long-term: 8 to 12 sessions of CBT usually make a huge difference and family therapy is generally only a few sessions, she adds.
Lifestyle changes are key too, including establishing routine in a patient’s life, such as taking medication regularly and following a balanced diet and exercise regime. The use of alcohol and other substances must be avoided.
It’s crucial that a patient takes full responsibility and accountability for their role in their treatment, advises Professor Schoeman. “Patients need to commit fully and accept that this is a road that we’re going to have to walk together: we may have to review, change and optimise treatment. Dedicated patients with good support systems and insight are very easy to treat as they grasp the concepts and skills quickly, while others find it more challenging.”